Questionnaires for screening relative energy deficiency in sport (RED-S) in women: a systematic review

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Abstract

BACKGROUND: Relative energy deficiency in sport (RED-S) and low energy availability are major issues in modern sports. The constant prevalence of energy expenditure on training and competition over energy intake is the main risk factor for these conditions to occur. Quantifying energy deficiency in everyday practice is rendered difficult, but questionnaires can be an effective tool for timely screening of low energy availability and RED-S.

AIM: To conduct a systematic review of questionnaires used to assess RED-S risk factors in athletes.

METHODS: The presented review was conducted in concert with the methodological guidelines found in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. A search was conducted through the PubMed, Google Scholar, Embase, Scopus, CINAHL, Medline Ovid, and SPORTDiscus electronic databases from January 2010 to February 2025. The review covered articles setting forth issues regarding the assessment of reproductive health and manifestations of RED-S.

RESULTS: Out of the 29 studies included in the review, ten unique questionnaires were found to identify athletes at risk of energy deficiency. Nine questionnaires were validated, three of which included only screening for eating disorders, without assessing other symptoms or training activity. Two questionnaires were most frequently used in studies and practice: the low energy availability in females questionnaire and the eating disorder examination questionnaire.

CONCLUSION: Questionnaires can be effective in identifying intentional energy restriction, early detection of gynecological pathology, and the risk of energy deficiency in female athletes. Questionnaires are screening tools but not methods for diagnosing RED-S.

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About the authors

Anastasiia E. Degteva

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: a.degteva@fomin-clinic.ru
ORCID iD: 0009-0006-0618-6346
SPIN-code: 6072-4730

MD

Russian Federation, 8 Svetlanovsky ave, Saint Petersburg, 194156

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